MAINTAINING INDEPENDENCE IN OLD AGE: POLICY CHALLENGES.

• Author: Dwyer, Maire

INTRODUCTION

As part of its contribution to the "International Year of Older Persons 1999", the Government commissioned research into the factors that help maintain the independence of older people. "Independent" was defined as remaining active and contributing to the community, while living either in a private residence or retirement village, alone or with others, and with or without support services. Alison Gray, Maire Dwyer and Marjory Renwick carried out the research,(2) under contract to the Senior Citizens Unit, and the Research Unit of the then Social Policy Agency. This article summarises the key policy challenges that emerged from the research.

Methodology

Information was collected through a literature review, key informant interviews, focus group discussions and letters. The key informants included service providers, local authority workers, health professionals, and members of community groups, researchers and academics. Focus group discussions were held with older people who were invited to discuss both the factors that help older people maintain their independence and any barriers to achieving this. They were also asked to suggest improvements to both policy and service delivery and in particular to identify interventions that they considered would be cost effective. The groups comprised 51 people from Wellington, the Kapiti Coast, Taranaki and Taihape. Their ages ranged from the mid-50s to the 90s. Thirty-six women and 15 men took part in the discussions. One group consisted entirely of Maori men and women; another included two Maori women. While these discussions included older people of varied ages and in different circumstances, they included few older people who were isolated, depressed or had severe disabilities. Sixty-four older people, and nine family members, friends or neighbours wrote to the project team giving their views on maintaining independence following a widespread invitation to participate. The report also drew on research currently being undertaken with older Pacific people in Wellington.

THE CONTEXT FOR CONSIDERING INDEPENDENCE OF OLDER PEOPLE

As in other western countries, older people are growing as a proportion of the New Zealand population. In 1996, 11.7% of the population (422,667 people) was 65 or over. This proportion is expected to peak at 25.5% of the population in 2050. The most rapid increase will be in the "old old". By 2031, people aged 80 and over are expected to make up 27% of those aged 65 and over. The ethnic composition of this population will become more diverse as the proportion of older Maori and Pacific people increases.

Most older people live at home. At the 1996 census, 92% of people 65 and over, and 87% of people 75 and over lived in private dwellings.

Ageing can involve decreased mobility and dexterity, decreased strength and stamina, and reduced sensory acuity. Statistically, the probability of morbidity or illness and some disabilities increases with age. Older people are often more affected by, and take longer to recover from sicknesses, such as influenza.

On the social side, ageing can involve isolation from family and friends, including the loss of peers. The composition of neighbourhoods may change as older people die or move out and younger families move in. To "age in place" successfully requires planning and often support from services as well as family, and may require physical changes to one's home.

Ageing does not occur at a uniform age or rate. While older people receiving institutional care have a greater average level of disability than those who are living independently, there is no unambiguous point of transition. Some people living independently have higher levels of disability than do others who are in institutional care. Most disabled older people, including those with severe disabilities, and high dependency on others, presently live in private households.

Important Factors in Maintaining Independence

The literature review confirmed that what individuals do, and what happens to them before they become old, is probably the most important influence on independence in old age. Individuals can enhance their chances of retaining independence by having a successful, healthy and active life before and after reaching old age. Financial resources, an active mind, good relationships with family and friends, fitness and health, and good self-esteem are all associated with being able to stay living independently. Even when serious disability or illness occurs, these personal resources and social capital increase choices, and enhance the likelihood that an individual can access services, be supported informally, and stay living independently. From the perspective of habits and confidence, older people are more likely to be active and happy in retirement, if this has been the case earlier in life.

There are, however, no guarantees. Old age is probably the most difficult phase of life for which an individual has to plan. Individuals face more uncertainty about key areas of their life when old, than at any other life stage. These include how long they, and their partner, will live and in what state of health. From these areas flow uncertainty about how long they will have the capacity to earn from work, to undertake jobs around the home, to drive and get around unassisted, to see, hear and communicate, and to remain active and motivated.

A number of other factors are critical to independence in old age. While the importance of each to individual older people varies, they emerged from the research in approximately the following order of priority:

* positive attitudes to ageing

* having adequate income

* support with personal health needs and needs arising from disability and degenerative conditions

* having appropriate housing and security

* access to transport

* opportunities for recreation, education and use of public amenities, and

* work.

Factors Influencing a Policy Response

Our research focus was on factors that support the independence of older people. In drawing up policy recommendations, we melded together the views of the older New Zealanders who took part in the research, our analysis of the key issues that...